National Cancer Institute

at the National Institutes of Health

Home Care Nursing Improves Cancer Symptom Management

Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16, 2009, in the Journal of Clinical Oncology. Researchers in the United Kingdom randomly assigned 164 patients with colorectal or breast cancer who were receiving capecitabine to either standard care or HCN and followed them for 4.5 months (6 chemotherapy cycles).

The study found that patients who received HCN experienced significant improvements in symptoms of oral mucositis, diarrhea, constipation, nausea, pain, fatigue, and insomnia compared with those in the standard care group. The benefits were most significant during the first two cycles of treatment. Individuals in the standard care group also had far greater unplanned use of health care resources, particularly days of inpatient hospital care (167 days versus 57 days for HCN patients).

An experienced nurse trained in home care and cancer care visited the patients assigned to HCN during their first week of chemotherapy. The nurse provided information about capecitabine and its side effects and answered questions during a 1 to 1.5 hour visit. Patients then received a weekly phone call from the nurse to assess side effects and discuss strategies for overcoming them. Patients who experienced multiple severe side effects (grade 3 or higher) or who otherwise had difficulty dealing with their chemotherapy received subsequent home care visits. Those assigned to standard care were provided with oral and written information about capecitabine by their physician and were prescribed medicines to deal with likely side effects. Patients who received standard care were assessed at baseline and then via a weekly telephone call from a research associate who did not provide medical advice.

Oral anticancer drugs are increasingly becoming part of the standard treatment regimens for many cancer types, so “it seems imperative to find ways to support patients at home,” the authors noted. A symptom-focused HCN program appears to be an effective way of providing that support, they concluded.